First Nation reserves without adequate water, housing and health infrastructure are in triple jeopardy in Canada. People living on First Nations are now facing the threat of the COVID-19 pandemic, many without critical infrastructure. First Nations leadership is doing what they can, but Truth and Reconciliation requires adequate funding and meaningful partnerships with First Nations. A new report “COVID-19, First Nations and Poor Housing: “Wash hands frequently” and “Self-isolate" akin to “let them eat cake” in First Nations with Overcrowded Homes lacking Piped Water” analyzes Canada’s self-help instructions during the pandemic considering health care and infrastructure, focused on Manitoban First Nation reserves.
Health and First Nation reserves
On First Nation reserves, people have higher disease rates, such as diabetes and tuberculosis (TB) than for the Canadian population. The crisis of overcrowded housing on First Nation reserves is linked to higher rates of many diseases including a 50 times higher prevalence of TB for people on First Nation reserves compared to other Canadians. Considering COVID-19 is much more contagious than TB, the risks from overcrowded First Nation housing for COVID-19 spreading are great. We have seen similar situations in the past, with the H1N1 pandemic. One of Manitoba’s 17 remote fly-in communities, Garden Hill First Natio,n had hundreds of people sick from H1N1 and three of the 11 Manitobans (27 per cent) who died from H1N1. Under such conditions, how can Manitoba First Nations follow the public health advice to prevent the spread of COVID-19?
Frequently washing your hands while rationing and running out of water
Washing hands is vital to prevent COVID-19, however lack of piped water on First Nation reserves creates barriers. Manitoba First Nations haul water by truck to cisterns at higher rates than any other province, at 31 per cent, while another 5 per cent have no water system. Cisterns often run out of water, with reports of half of the homes in Norway House Cree Nation “often left without water for one to 10 days”. Water systems are also prone to breakdown. In Wasagamack, an Elder condemned the one-week failure of the water treatment system this month: “With the big concern over COVID-19, we have no water supply to the health centre and community.” In 2017, the Parliamentary Budget Office calculated that more than $3.2 billion is required for First Nation on-reserve water systems to be on par with Canadian communities. COVID-19 causes us to critically question why First Nations still have issues accessing safe drinking water.
Self-Isolation and physical distancing in an overcrowded house
Health Canada recommends people isolate at home if they may have COVID-19 and social distance to “flatten the curve”. According to the Statistics Canada, 37 per cent of First Nations people on reserve lived in unsuitable housing due to being overcrowded, compared to 8.5 per cent for the non-Indigenous population in 2016. In remote First Nations, rates are even higher at 53 per cent for both Wasagamack and Garden Hill First Nations. Another example in St. Theresa Point First Nation, the Chief reported 23 people living in a two-bedroom home where "They had to take turns sleeping." The overcrowding on reserves results in First Nations people having a higher incidence of precarious housing or homelessness (e.g., living in homeless shelters, transitional housing, or residential facilities for victims of abuse).
Lack of health care facilities
Most First Nations in Northern Manitoba have smaller health care facilities, such as nursing stations, typically requiring people living on reserves to travel far distances to meet their health care needs. The lack of nearby hospitals, particularly for communities lacking access roads, are barriers to health care. Research shows one in ten First Nations’ people on reserve across Canada have unmet health care needs in the preceding 12 months. Facilities to isolate sick people on First Nation reserves are limited. Those in remote communities, who would need ventilators or acute care for COVID-19, must fly out for emergency medical care, presenting a transportation bottleneck. For example, in Wasagamack helicopters are needed to reach the airport during the two months or more of ice-break-up/freeze-up (May and November typically).
First Nations are in a State of Emergency
First Nations leaders have declared states of emergencies to protect their First Nation communities, knowing that their lack of infrastructure is a death sentence under COVID-19. The Chiefs of northern Manitoba First Nations called on the Province to cut off travel to the north, which was initially rejected. On April 17, 2020, the Province did enact a "travel ban for northern Manitoba (north of the 53rd parallel), with exceptions for essential travel". As of May 10, 2020, 175 positive COVID-19 cases are confirmed on First Nations reserves in provinces (British Columbia at 39, Alberta at 29, Saskatchewan at 35, Ontario at 41 and Quebec at 31), resulting in 17 hospitalizations and two deaths (ISC, 2020c). Lockdowns have effectively prevented the transmission from reaching remote communities and Nunavut to date. However, corporations, such as HudBay, are permitted by the province to continue mining with workers travelling in and out of northern Manitoba, risking transmission from miners as occurred in Gull Lake First Nation in Northern Ontario.
Conclusion and Policy recommendations
With the overcrowding of homes, lack of clean water, and lack of infrastructure, particularly in remote and northern communities, just one COVID-19 case on a reserve could devastate the community. Prevention is needed through supporting the First Nation leaderships’ blockades and lockdowns and more funding to support basic needs. The roots of the health inequity must be addressed to prevent dire consequences. A change in governance to First Nation self-government, capacity building and adequate funding is needed to bring about reconciliation and adequate infrastructure for First Nation reserves to protect the health of First Nations peoples. First Nations people hold the answers to their own wellbeing and it is time Federal government listened and funded these solutions.
Full report available: www.policyalternatives.ca